Skip to main content

Thoracic Outlet Syndrome: Definition, Aetiological Factors, Diagnosis, Management and Occupational Impact

Journal of Occupational Rehabilitation volume 21, pages 366–373 (2011)Cite this article

Abstract

Introduction Thoracic outlet syndrome is a controversial cause of neck and shoulder pain due to complex mechanisms involving muscular dysfunction and nerve compression. Although management of thoracic outlet syndrome must be based on a multidisciplinary approach, physicians and occupational therapist should be familiar with the principles of diagnosis and treatment. Method, results and conclusion The purpose of this article is to review the definitions, diagnosis and management of this syndrome. A particular emphasis was described on the links between the workplace and the individual in the pathogenesis, prevalence in the workforce and the course of this disease.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Roquelaure Y, Ha C, Leclerc A, Touranchet A, Sauteron M, Melchior M, et al. Epidemiologic surveillance of upperextremity musculoskeletal disorders in the working population. Arthritis Rheum. 2006;55:765–78.

    PubMed  Article  Google Scholar 

  2. Kuijpers T, van Tulder MW, van der Heijden GJ, Bouter LM, van der Windt DA. Costs of shoulder pain in primary care consulters: a prospective cohort study in The Netherlands. BMC Musculoskelet Disord. 2006;7:83.

    PubMed  Article  Google Scholar 

  3. Kieffer E. Les syndromes de la traversée thoraco-brachiale. In: Actualités de chirurgie vasculaire. Paris: A.E.R.C.V. éditions; 1989.

    Google Scholar 

  4. Riddell DH, Smith BM. Thoracic and vascular aspects of thoracic outlet syndrome. Clin Orthop. 1986;207:31–6.

    PubMed  Google Scholar 

  5. Roos DB. Congenital anomalies associated with thoracic outlet syndrome. Am J Surg. 1976;132:771–8.

    PubMed  Article  CAS  Google Scholar 

  6. Roos DB. Thoracic outlet syndromes. Am J Surg. 1987;154:568–73.

    PubMed  Article  CAS  Google Scholar 

  7. Hérard J, Le Dû C, Corcia P, Laulan J. Devenir à long terme, clinique et électrique, des syndromes du canal carpien opérés. Facteurs pronostiques cliniques. 42 e congrès du GEM, Paris décembre 2006.

  8. Lascar T, Laulan J. Cubital tunnel syndrome: a retrospective review of 53 anterior subcutaneous transpositions. J Hand Surg. 2000;25B:453–6.

    Google Scholar 

  9. Adson AW. Surgical treatment for symptoms produced by cervical ribs and the scalenus anticus muscle. Clin Orthop. 1986;207:3–12.

    Google Scholar 

  10. Merle M. Les syndromes de la traversée cervico-thoraco-brachiale. Monographie des Annales de Chirurgie de la Main. 1995;7:29–47.

    Google Scholar 

  11. Ellison DW, Wood VE. Trauma-related thoracic outlet syndrome. J Hand Surg. 1994;19B:424–6.

    Google Scholar 

  12. Sanders RJ, Jackson CG, Banchero N, Pearce WH. Scalene muscle abnormalities in traumatic thoracic outlet syndrome. Am J Surg. 1990;159:231–6.

    PubMed  Article  CAS  Google Scholar 

  13. Barton NJ, Hooper G, Noble J, Steel WM. Occupational causes of disorders in the upper limb. Br Med J. 1992;304:309–11.

    Article  CAS  Google Scholar 

  14. Mackinnon SE, Novak CB. Clinical commentary: pathogenesis of cumulative trauma disorder. J Hand Surg. 1994;19A:873–83.

    Google Scholar 

  15. Novak CB, Mackinnon SE, Patterson GA. Evaluation of patients with thoracic outlet syndrome. J Hand Surg. 1993;18A:292–9.

    Google Scholar 

  16. Machleder HI, Moll F, Verity A. The anterior scalene muscle in thoracic outlet compression syndrome. Histochemical and morphometric studies. Arch Surg. 1986;212:1141–4.

    Google Scholar 

  17. Fouquet B, Pellieux S, Métivier JC, Laulan J. Facteurs psychiques et psychologiques des syndromes tunnellaires. In: Membre supérieur et pathologie professionnelle. Paris: Masson; 2001. p. 72–78.

  18. Sallstrom J, Schmidt H. Cervicobrachial disorders in certain occupations, with special reference to compression in the thoracic outlet. Am J Ind Med. 1984;6:45–52.

    PubMed  Article  CAS  Google Scholar 

  19. Pascarelli EF, Hsu YP. Understanding work-related upper extremity disorders: clinical findings in 485 computers users, musicians, and others. J Occup Rehabil. 2001;11:1–21.

    PubMed  Article  CAS  Google Scholar 

  20. Rosset P, Martinat H, Barsotti J, Gaisne E. Exostose ostéogénique de la première cote: une étiologie rare de syndrome de la traversée thoraco-brachiale. Rev Chir Orthop. 1990;76:62–5.

    PubMed  CAS  Google Scholar 

  21. Alexandre J, Le Dû C, Corcia P, Laulan J. Formes déficitaires du syndrome de la traversée thoraco-brachiale. A propos de 16 cas. 41 e congrès du GEM, Paris, décembre 2005.

  22. Allieu Y, Benichou M, Touchais S, Desbonnet P, Lussiez B. Les formes neurologiques du syndrome du hile du membre supérieur: le rôle du scalène moyen. Ann Chir Main. 1991;10:308–12.

    CAS  Google Scholar 

  23. Dahlin LB, Lundborg G. The neurone and its response to peripheral nerve compression. J Hand Surg. 1990;15B:5–10.

    Google Scholar 

  24. Upton ARM, McComas AJ. The double crush in nerve entrapment syndromes. Lancet. 1973;2:359–61.

    PubMed  Article  CAS  Google Scholar 

  25. Bontoux L, Fouquet B, Laulan J, Raimbeau G, Roquelaure Y, Vannier I. Les syndromes douloureux chroniques du MS: place de la chirurgie. Table ronde sous la direction de J. Laulan et B. Fouquet. Chir Main. 2009;28:207–18.

    PubMed  Article  CAS  Google Scholar 

  26. Narakas AO. The role of thoracic outlet syndrome in the double crush syndrome. Ann Chir Main. 1990;9:331–40.

    CAS  Google Scholar 

  27. Turner A, Kimble F, Gulyás K, Ball J. Can the outcome of open carpal tunnel release be predicted?: a review of the literature. ANZ J Surg. 2010;80:50–4.

    PubMed  Article  Google Scholar 

  28. Monsivais JJ, Sun Y, Rajashekhar TP. The scalene reflex: Relationship between increased median or ulnar nerve pressure and scalène muscle activity. J Reconstr Microsurg. 1995;11:271–5.

    PubMed  Article  CAS  Google Scholar 

  29. Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10:895–926.

    PubMed  Article  Google Scholar 

  30. Smith TM, Sawyer SF, Sizer PS, Brismée JM. The double crush syndrome: a commonoccurrence in cyclists with ulnar nerve neuropathy-a case-control study. Clin Sport Med. 2008;18:55–61.

    Article  Google Scholar 

  31. Laulan J, Le Dû C. Chirurgie des lésions tendineuses du coude. EMC (Elsevier Masson SAS, Paris), Techniques chirurgicales—Orthopédie-Traumatologie. 2007; 44–315.

  32. Mackinnon SE, Novak CB. Clinical commentary: pathogenesis of cumulative trauma disorder. J Hand Surg. 1994;19-A:873–83.

    Google Scholar 

  33. Novak CB, Mackinnon SE, Patterson GA. Evaluation of patients with thoracic outlet syndrome. J Hand Surg. 1993;18A:292–9.

    Google Scholar 

  34. Laulan J, Debrade O, Barsotti J. Syndrome de la traversée thoraco-brachiale et activités professionnelles. In: Hérisson C, Fouquet B, editors. Ceinture scapulaire et pathologies professionnelles. Paris: Masson; 2003. p. 81–92.

    Google Scholar 

  35. Sanders RJ, Hammond SL, Rao NM. Thoracic outlet syndrome: a review. Neurologist. 2008;14:365–73.

    PubMed  Article  Google Scholar 

  36. Morley J. Brachial plexus neuritis due to a normal first thoracic rib: its diagnosis and treatment by excision of rib. Clin J. 1913;13:461–3.

    Google Scholar 

  37. Laulan J, Bacle G. Défilé thoracobrachiaux: formes pures et formes complexes. In: Cervicoscapulagies professionnelles. Paris: Masson; 2010. p. 61–67.

  38. Gockel M, Lindholm H, Vastamaki M, et al. Cardiovascular functional disorder and distress among patients with thoracic outlet syndrome. J Hand Surg. 1995;20-B:29–33.

    Google Scholar 

  39. Miller MH, Topliss DJ. Chronic upper limb pain syndrome (repetitive strain injury) in the Australian workforce: a systematic cross sectional rheumatological study of 229 patients. J Rheumatol. 1988;15:1705–12.

    PubMed  CAS  Google Scholar 

  40. Nakatsuchi Y, Saitoh S, Hosaka M, Matsuda S. Conservative treatment of thoracic outlet syndrome using an orthosis. J Hand Surg. 1995;20B:34–9.

    Google Scholar 

  41. Peet RM, Henriksen JD, Anderson TP, Martin GM. Thoracic-outlet syndrome: evaluation of a therapeutic exercise program. Mayo Clin Proc. 1956;31:281–7.

    CAS  Google Scholar 

  42. Aligne C, Barral X. La rééducation des syndromes de la traversée thoraco-brachiale. Ann Chir Vasc. 1992;64:381–9.

    Article  Google Scholar 

  43. Revel M, Armor B. Rééducation des syndromes de la traversée cervico-thoraco-brachiale (à propos de 26 cas). Méd Hyg. 1983;41:1140–3.

    Google Scholar 

  44. Fouquet B, Métivier JC, Flahaut E, Enogat E, Bourlier C. Stratégie de prise en charge des troubles musculo-squelettiques en médecine physique et réadaptation. In: Membre supérieur et pathologie professionnelle. Paris: Masson; 2001. p. 139–44.

    Google Scholar 

  45. Gockel M, Vastamaki M, Alaranta H. Long-term results of primary scalenectomy in the treatment of thoracic outlet syndrome. J Hand Surg. 1994;19B:229–33.

    Google Scholar 

  46. Ohlsson K, Attewell RG, Johnsson B, Ahlm A, Skerfving S. An assessment of neck and upper extremity disorders by questionnaire and clinical examination. Ergonomics. 1994;37:891–7.

    PubMed  Article  CAS  Google Scholar 

  47. Battevi N, Menoni O, Vimercati C. The occurrence of musculoskeletal alterations in worker populations not exposed to repetitive tasks of the upper limbs. Ergonomics. 1998;41:1340–6.

    PubMed  Article  CAS  Google Scholar 

  48. Lederman RJ. Neuromuscular problems in musicians. Neurologist. 2002;8:163–74.

    PubMed  Article  Google Scholar 

  49. Hagberg M. Wegman DH Prevalence rates and odds ratios of shoulder-neck diseases in different occupational groups. Br J Ind Med. 1987;44:602–10.

    PubMed  CAS  Google Scholar 

  50. Kahn MF. Problèmes rhumatismaux spécifiques des musiciens. Rev Rhum Mal Ostéoartic. 1992;59(6 bis):63S–8S.

    PubMed  CAS  Google Scholar 

  51. Fiorentini C, Mattioli S, Graziosi F, Bonfiglioli R, Armstrong TJ, Violante FS. Occupational relevance of subclavian vein thrombosis in association with thoracic outlet syndrome. Scand J Work Environ Health. 2005;31:160–3.

    PubMed  Google Scholar 

  52. Roquelaure Y, Petit Le Manach A, Serazin C, Laulan J, Descatha A, Aublet-Cuvelier A, Spiesser-De Brouard C, Valenty M, Ha C, Imbernon E. Le syndrome de la traversée thoraco-brachiale est-il une maladie professionnelle? Cervicoscapulagies professionnelles. Paris: Masson; 2010. p. 68–74.

    Google Scholar 

  53. Fouquet B, Borie JM. Syndromes de la traversée thoraco-brachiale: sont-ils d’origine professionnelle? Cervicoscapulagies professionnelles. Paris: Masson; 2010. p. 75–89.

    Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Unité de chirurgie de la main, service de chirurgie orthopédique, CHU Trousseau, Tours, France

    Jacky Laulan

  2. Service de médecine physique et de réadaptation, CHU Trousseau, Tours, France

    Bernard Fouquet

  3. Unité de pathologie professionnelle, UVSQ-APHP, Hôpital Raymond Poincaré, 104 bd Poincaré, 92380, Garches, France

    Camille Rodaix, Penelope Jauffret & Alexis Descatha

  4. Laboratoire d’ergonomie et d’épidémiologie en santé au travail (LEEST), Unité associée à l’Institut de veille sanitaire, UPRES EA 4336, Université d’Angers, CHU, Angers, France

    Yves Roquelaure

  5. UVSQ-Inserm, U1018, Villejuif, France

    Alexis Descatha

Authors
  1. Jacky Laulan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bernard Fouquet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Camille Rodaix
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Penelope Jauffret
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yves Roquelaure
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexis Descatha
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexis Descatha.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Laulan, J., Fouquet, B., Rodaix, C. et al. Thoracic Outlet Syndrome: Definition, Aetiological Factors, Diagnosis, Management and Occupational Impact. J Occup Rehabil 21, 366–373 (2011). https://doi.org/10.1007/s10926-010-9278-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10926-010-9278-9

Keywords

  • Thoracic outlet syndrome
  • Rehabilitation
  • Diagnosis
  • Occupational disease